External Site Reviews
MSHN has external quality reviews completed by the Michigan Department of Health and Human Services (MDHHS) and the Health Services Advisory Group (HSAG). To comply with requirements of the Center for Medicare and Medicaid Services (CMS), MDHHS completes a review of the PIHPs for services provided under the 1915(c) Home and Community Based Service Waivers (HCBS), 1915(i) State Plan Amendment, and Substance Use Services.
MDHHS contracts with HSAG to measure and report on performance to assess the quality and appropriateness of care and services provided to members. HSAG reviews include Performance Measure Validation (PMV), Network Adequacy Validation (NAV), Performance Improvement Project (PIP), Encounter Data Validation (EDV), and Compliance Monitoring.
HSAG Performance Measure Validation (PMV) Review
The purpose of the Performance Measure Validation (PMV) review is to assess the accuracy of performance indicators reported by the PIHPs and to determine the extent to which performance indicators reported by the PIHPs follow state specifications and reporting requirements.
HSAG Compliance Monitoring Review
The purpose of the Compliance Monitoring review is to determine the PIHP’s compliance with the standards set forth in 42 CFR §438—Managed Care Subpart D and the quality assessment and performance improvement requirements described in 42 CFR §438.330.
HSAG Performance Improvement Project
The purpose of the Performance Improvement Project (PIP) review is to comply with the MDHHS requirement that the PIHP conduct and submit performance improvement projects (PIPs) annually to comply with the Balanced Budget Act of 1997 (BBA), which states that the quality of health care delivered to Medicaid enrollees in PIHPs must be tracked, analyzed, and reported annually. PIPs provide a structured method for assessing and improving the processes, and thereby the outcomes, of care for the population a PIHP serves.
MDHHS Waiver Reviews
The Michigan Department of Health and Human Services (MDHHS) conducts annual reviews of 1915(c) Home and Community Based Service Waivers (HCBS) and 1915(i) State Plan Amendment review from May 18, 2026, through July 31, 2026. MSHN compliance for the region by program is as follows:
- 100% Administrative review
- 90% Habilitation Supports Waiver (HSW)
- 88% Children with Serious Emotional Disturbance (SEDW)
- 95% Children’s Waiver Program (CWP)
- 86% 1915(i)SPA
The MSHN region submitted individual and systemic remediation plans for any performance measures it did not meet.
MDHHS Substance Use Services Review
The Michigan Department of Health and Human Services (MDHHS), Division of Substance Use, Gambling, and Epidemiology (SUGE), conducted a review in January 2026. MDHHS reviewed areas of provider network, specific program requirements, Level of Care coordination, Women’s Specialty requirements, Charitable Choice, Fetal Alcohol Spectrum Disorders prevention activities, Communicable Disease, and Opioid Use Disorder Treatment.
MSHN scored 97% compliance. MSHN submitted a plan of correction for the standards it did not fully meet.